Per 1994 Dietary Supplement Health Education ActDietary Supplement Health Education Act • A dietary supplement is a product taken by mouth that contains a "dietary ingredient" intended

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DietarySupplements:WhattheDentalTeamShouldKnow

TieraonaLowDog,MD

FellowshipDirector,AcademyofIntegrativeHealth&Medicine

Copyright © 2016 Integrative Medicine Concepts, LLC. All Rights Reserved.

Per1994

DietarySupplementHealthEducationAct

• Adietarysupplementisaproducttakenbymouththatcontainsa"dietaryingredient"intendedtosupplementthediet.

• The"dietaryingredients"intheseproductsmayinclude:vitamins,minerals,herbsorotherbotanicals,aminoacids,andsubstancessuchasenzymes,organtissues,glandulars,andmetabolites.

• Dietarysupplementscanalsobeextractsorconcentrates,andmaybefoundinmanyformssuchastablets,capsules,softgels,gelcaps,liquids,orpowders.


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• SincepassageofDSHEA,themarketplacehasgrownfromroughly4,000productstomorethan29,000.

• ThesheernumberandvariationinproductsmakesitdifficultforclinicianstocounselpatientsaboutDSuse.

Tsourounis,etal.Clin Pharmacol Ther 2010;87(2):147-9


CentersforDiseaseControl

• Recentfindingshavedetermined thatlessthanoptimalbiochemicallevelsofvitaminsandmineralsareassociatedwithrisksofadversehealtheffects.

• “Thesehealtheffectsincludecardiovasculardisease,stroke,impairedcognitive function,cancer,eyediseases,poorbonehealth,andotherconditions.”

CDC:2nd NationalReportonBiochemicalIndicatorsofDietandNutritionintheU.S.Population


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TheB-vitamins

• Vitally importantforproductionofenergy,maintenanceofahealthybrainandnervoussystemandhealthyfunctionofthecardiovascularsystem.

• LowlevelsofvitaminB6andB12increaseriskfordepressionandimpaircognition,attention,andmemory.

• CDCfoundthatmost womentakingbirthcontrolpillswerelowinvitaminB6.

• 2/3rd ofthosewithB12deficiencyareoverage40.• Womenwhodonoteatfortifiedfoodsmaynotbe

gettingsufficientfolate,significant ifpregnancyoccurs.

Copyright©2016IntegrativeMedicineConcepts,LLC.AllRightsReserved.

The“Stress”B- Vitamins

MTHFR

Folate 5-MTHF+Homocysteine 1-Met SAMe

DA

5-HT

NE

M

E

TH

YI

D

ON

AT

I

ON

Metsynthase Mat

Methylcobalamin

(vitaminB-12)


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FoodFortification

• ManycerealsarefortifiedwithvitaminsB1,B2,B3,B5,B9,B12,andC,aswellasironand

calcium.

• Thishasbothanupsideanddownside(potentiallygettingtoomuchanutrient;for

instanceironinadultmen).

• Furthercomplicatingtheissue:mostnon-GMOand/ororganiccerealsarenotfortified.


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WomenandFolate

• Womenwhoareofreproductiveageneed400mcg/dayoffolate atleast2-3monthsbeforepregnancytoreducetheriskofneuraltubedefects.

• Folicacidreceived throughfoodfortificationinthe US islessthan130mcg/day,makingsupplementationimportant.

• Giventhatmanywomenareavoidingglutencontainingfoods,thecontributionfromfortifiedfoodsislikelyevenlower.


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VitaminB6

• 30millionpeoplearedeficient(PLP<20nmol/L)• In2012,Tuft’sUniversity researchersconfirmedasinflammationinbody rises,B6levelsfalls.

• EvenmarginallylowPLPlevels(20–30nmol/L) increasetheriskofCADandstroke.

• Meta-analysis13studies (JAMA,2010)foundB6isinverselycorrelatedwithreductionincolorectalcancer.

• WomenalmosttwiceaslikelytobedeficientinB6asmenanddeficiency ratesforblacks(15.7%)arehigherthanforwhites(10.7%).

CDC2nd NationalReportonBiochemicalIndicatorsof DietandNutritionintheU.S.Population


ToGet1.5mgB6inFood(Need4-6mgfornormalbloodlevels)

• 2.5bananas• 12Tbsp.roastedsunflowerseeds• 8 ounceschickenbreast• 8 ouncessockeyesalmon• 3.5cupsrawdicedavocado• 3cupssweetpotatoes• 15cupsofmilkOR• 20Tbsp.peanutbutter


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Case41-yearoldFemale

• Strict vegan for 2.5 years. Disturbance of taste (unable to sense flavor of variety of fruits and vegetables), fatigue after simple daily activities, paresthesia of the anatomic structures innervated by the mandibular division of the trigeminal nerve on her left side, disturbance of memory and slowing mental faculty. No meds. No significant medical or dental history.

Pontes HA, et al. J Can Dent Assoc 2009; 75(7):533-7.



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LabTests


Patienttreatedwith1000mcgB12IMperweekfor4weeksand1mgfolate daily.

Symptomsdisappearedafter14daysoftreatment.


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VitaminB12

• Foundinanimalandfortifiedfoods.KeyroleinDNAsynthesis,hematopoiesisandneurologicalfunction.

• Deficiencydamagesmyelinsheathcoveringcranial,spinal,andperipheralnerves,resultinginneurologicaldamage.

• Myelinationprimarilyoccursduringfetaldevelopmentandearlyinfancybutcontinuesthroughearlyadulthood.

• Risk:inadequateintake,veganism,malabsorption,medications,obese,insulinresistantadolescents.

• MMAlevel>271nmol/Lismostreliablemeasureofdeficiency(aimforserumlevelB12500-800pg/ml)

Niafar M,etal.InternEmerg Med2015;10(1):93-102.


MetabolismofB12

• Entersstomach,HCLandpepsinseparateB12fromproteininanimalfood

• FreeB12joinedtoproteincalledintrinsicfactor(IF)madebyparietalcellsinstomach.

• B12-IFtravelstoileumwhere,ifcalciumisadequate,itisabsorbed.


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MetforminWithProtonPumpInhibitors:APolypharmacyRecipeforNeuropathyvia

VitaminB12DepletionZdilla MJ.Clin Diabetes2015;33(2):90-5.


DeJager,et al.BMJ2010;340:c2181


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Riboflavin(B2)

• Crucial forabsorptionanduseofiron.Primarysourceinwesterndietisdairy&fortifiedfoods.

• LaboratorydatainUKfound95%of15-18yearoldgirlshadlowriboflavinlevels.

• FiveyearstudyinChinafoundstrongcorrelationbetweenlowriboflavinandirondeficiencyanemia.

• ConsiderB-vitaminsingirlswithirondeficiencywhomaybeatriskforlowdietaryintake.

PowersHJ.AmJClin Nutr 2003;77(6):1352-60


Choline• WatersolublenutrientintheB-vitaminfamilythatis

particularlycrucialduringpregnancyandthefirstthreeyearsofachild’slife.

• Deficiencymaybeassociatedwithpermanentchangesinbrainfunctionthatnegativelyimpactintelligence,memory,moodregulation,andstressresponse.

• Preclinicalstudiesshowcholinepartiallyamelioratesmemoryandlearningdeficitsfromprenatalalcoholexposure.

• Playscriticalroleinthepreventionoffattyliver.• RDA:450mgperday.Breastfeeding:550mgperday

JiangX,etal.TrendsEndocrinolMetab 2014;25(5):263-73.JiangX,etal.FASEBJ.2012;26(8):3563–3574.

WozniakJR,etal.Nutr Res2013;33(11):897-904


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CholineinPregnancy

• Suboptimal intakeofcholinewasfoundin95%ofpregnantwomeninBoston.

• Lowcholineintakeintake increasestheriskofneuraltubedefects byupto4times.

• RDAforcholineinpregnancyis450mgperdayand550mgperdayifbreastfeeding.

ShawGM,etal.Am.J.Epidemiol.2004;160,102–109Brunst KJ,etal.PublicHealthNutr 2014;17(9):1960-70

JiangX,etal.FASEBJ.2012;26(8):3563–3574.

.Copyright © 2016 Integrative Medicine Concepts, LLC. All Rights Reserved.

CholineinFoods:http://naldc.nal.usda.gov/download/47335/PDF

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Iron

• WHO:irondeficiencymostcommonnutrientdeficiency inworld,affecting2billionpeople.– Irondeficiencyanemiaaccountsfor20%ofallglobalmaternaldeaths.

• Necessaryforgrowthanddevelopmentandessential componentofhemoglobin.

• Meta-analysisfoundthatironsupplementationimprovedattention,concentration,andIQ.

• Irondeficiency increases theriskofleadtoxicity

FalkinghamM,etal.Nutr J2010;25;9:4.CalargeC,etal.JChildAdolescPsychopharmacol.

2010;20(6):495–502Copyright © 2016 Integrative Medicine Concepts, LLC. All Rights Reserved.

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IroninFood

• Twoformsofiron:heme andnon-heme.Meatcontainsboth forms,whileplantsandfortified

foodscontainonlynon-heme iron.

• Weabsorbroughly18%ofironpresentinmeat,comparedtoabout10%inplants.

• Youcanincreaseabsorptionofnon-heme ironifmealcontainsvitaminC.


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ToGet18mgofIroninFood

• 4cupsraisins• 3–5cupsinstantoatmeal• 3cupsSpecialKcereal• 3cupscookedlentils• 2.2cupscannedwhitebeans• 10ouncesbeefliver• 45ounceschickenbreast• 15cupsbroccoli• 3cupscookedspinach


Warning:Iron

• Peoplewhoarenotatriskofirondeficiency(teenageboys,adultmen,womenwithinfrequentmenstrualcycles,andpostmenopausalwomen)shouldNOT takemultivitamins thatcontainironorironsupplementsunlessinstructedtodosobytheirhealthcareprovider.

• Whentakingsupplements:Lookforironbisglycinate,ferrousbisglycinate,orironglycinateonthelabel. TakewithvitaminCandNOTwithcalcium.


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VitaminC

• Playsaroleinactivating folicacid,assistsinconversionoftryptophantoserotonin,andisacofactorinsynthesisofcarnitine, thyroxin,norepinephrine,anddopamine.

• VitaminClevelsdecline rapidlyduringperiodsofemotionalandphysicalstrain,andillness.

• Aslevelsfall,collagensynthesisisimpaired:bruisemoreeasily,skinbecomesthickanddry,woundstakelongertoheal,jointshurt,fatigue.

• 15.7millionAmericanshavevitaminCdeficiency.


• “GiventheconsistenteffectofvitaminConthedurationandseverityofcoldsintheregularsupplementationstudies,andthelowcostandsafety,itmaybeworthwhileforcommoncoldpatientstotestonanindividualbasiswhethertherapeuticvitaminCisbeneficialforthem.”

• Doseof200-500mgperdayisprobablyagoodtarget.

Hemila H,etal. CochraneDatabaseSyst Rev2013; Jan31;1:CD000980.

VitaminCandCommonCold


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Tamiflu• In 2009, widespread concern about a new flu pandemic,

caused billions to be spent stockpiling Tamiflu globally. Sales that year hit $3 billion.– WHO recommends Tamiflu, but did not vet data.– EMA approved Tamiflu, but did not review the full

Tamiflu dataset.– CDC and ECDC encourage the use and stockpiling of

Tamiflu, but did not vet the Tamiflu data.– The majority of Roche's Phase III treatment trials

remain unpublished over a decade after completion.– In 2009, scientists requested Roche to hand over

data for evaluation……


The Findings

• In October 2013, Cochrane reviewers received the full Clinical Study Reports for 107 studies from Roche and GlaxoSmithKline. Here were their findings:– Reduction in time to first alleviation of symptoms from 7 days to

6.3 days compared with the control group. – No evidence it reduces hospitalizations or complications of flu:

pneumonia, bronchitis, sinusitis, ear infections in adults or kids– In prophylaxis trials, reduced flu-like symptoms in adults but did

not prevent person-to-person spread.– Increases risk of vomiting, headaches, psychiatric syndromes

and a statistically significant increase in renal events.


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Concluding Thoughts• ThestatedintentionsofgovernmentstodistributeTamifluto

healthypeopletopreventcomplicationsandinterrupttransmissionofinfluenzaon thebasisofapublishedevidencebasethathasbeenaffectedbyreportingbias,ghost

authorship,andpoormethodsisworrisome.

• “Webelievethesefindingsprovidereasontoquestionthestockpilingofoseltamivir,itsinclusionontheWHOlistofessentialdrugs,and itsuseinclinicalpracticeasananti-influenzadrug.”

JeffersonT,etal.BritishMedicalJournal2014;348:g2545.


Echinaceapurpurea• 473patientswhohadexhibitedflu

symptomsforlessthan48hoursrandomizedtoechinacea +elderberryortamiflu.

• Nodifferencebetweenrecoveryrates,antibioticuse,intermediatedoctorvisits,useofover-the-countermedicationsforsymptoms,“abilitytoreturntonormaldailyactivities,”orphysician- andpatient-reportedefficacyofthetreatments.

• Safetyfromnumeroustrialsisverypositive.

Rauš K,etal.Curr Ther Res.2015;doi:10.1016/j.curtheres.2015.04.001.

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ElderberrySambucus nigra

• Anthocyanidins havepotentantiviralandimmuneprimingeffects.• Antimicrobial activityagainstGram-positivebacteria Streptococcuspyogenes

andgroupCandG Streptococci, andGram-negativeMoraxellacatarrhalis.• Elderberry flavonoidsinhibit H1N1toroughlysamedegreeastamiflu and

amantadine.

• Extract reducessymptomsofinfluenzaAorBinpatients• Takeelderberry extractsasinstructed onlabel(crude equivalent5000-6000

mg)1-4timesperday

Krawitz C,etal.BMCComplementAltern Med2011;11:16.

Roschek,etal.Phytochemistry 2009;70(10):1255-61.Zakay-Rones Z,etal.JInt MedRes2004;32(2):132-40.



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Zinc

• Zincplaysavitalroleinourimmuneresponse.• NeedzinctoactivateT-lymphocytes,immunecellsresponsiblefordestroyingcellsinfectedwithvirusesorbacteria,orcancerous.

• Marginalzincdeficiencycanalsodiminishtheactivityofotherimportantimmunecellssuchasmacrophages,neutrophils,andnaturalkillercells.

• WHOestimatesmarginalzincstatusresultsinthedeathsof>780,000childrenundertheagefiveeveryyearfromdiarrhealdiseases,pneumonia,andmalaria.

• Noteffectivelystored,mustbecontinuouslyreplacedinthediet.


• Zinc administered within 24 hours of onset of symptoms reduces the duration of common cold symptoms in healthy people

• Zinc lozenges formulation have been shown to lead to a significant reduction in the duration of cold at a dose of ≥ 75 mg/day

Singh M, et al. Cochrane Database Syst Rev 2013; 6:CD001364

Zinc:Treatmentof

CommonCold


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ZincandTaste

• Onesignofzincdeficiencyisred,swollen,andtendergumsthatmaybleedafterbrushing.

• Study found half of women undergoing chemotherapy for gynecological cancer experienced altered taste.

• Serum zinc level consistently below lower limit of normal.• RDBPCT of adult patients with head and neck cancers

received zinc sulfate (50 mg, three times a day) or placebo at start of radiation through one month post. Zinc prevented radiation induced taste alterations.

Nishijima S, et al. Gynecol Oncol 2013; 131(3):674-8. Najafizade N, et al. J Res Med Sci 2013; 18(2):123-6

Copyright © 2009-2015 Integrative Medicine Concepts, LLC. All Rights Reserved.

Zinc and Oral Health

• A review of clinical trials found “moderate quality evidence that zinc supplements improve overall taste improvement in patients with zinc deficiency/idiopathic taste disorders.”

• Zinc deficiency detected in 28% of recurrent aphthous stomatitis patients compared to controls.

Nagraj SK, et al. Cochrane Database Syst Rev 2014; 2014 Nov 26;11:CD010470. Ozler GS. J Laryngol Otol 2014; 128(6):531-3


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ZincandMen

• Menhaveahigherdailyrequirementforzincbecauseitisusedfortheproduction of

testosterone,makingitanimportantnutrient

formalesexualmaturationandreproduction.

• Zincconcentrationsveryhighintheprostategland,testes,andinsperm.Deficiencyofthis

importanttracemineralmightcontributeto

lowertestosteroneandinfertilityinmen.


• Zinc deficiency: loss of appetite; lack of taste or smell; poor wound healing; acne; hair loss; lack of menstrual period; night blindness; and depression

• Vegetarians need as much as 50% more zinc due to lower absorption of zinc from plant foods. DV= 15 mg

• ACE inhibitors and thiazide diuretics deplete zinc

• Best absorbed on empty stomach. Do not take more than 40 mg per day for more than a few days without medical supervision. Take 2 hours apart from medication, especially quinolones and tetracycline antibiotics.

Zinc

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ZincandMen

• Menhaveahigherdailyrequirementforzincbecauseitisusedfortheproduction of

testosterone,makingitanimportantnutrient

formalesexualmaturationandreproduction.

• Zincconcentrationsveryhighintheprostategland,testes,andinsperm.Deficiencyofthis

importanttracemineralmightcontributeto

lowertestosteroneandinfertilityinmen.


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Deficiency

• Oneofthefirstsignsofcalciumdeficiencyismusclecramping.

• Muscleachesofthighsandarms,withminimalexertion,couldindicateadeficiencyofcalcium,vitaminD,and/ormagnesium.

• Longtermdeficiencyleadstopoorbonedevelopment/loss ofbonemineraldensity.


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CalciumandPMS

• TwosystematicreviewsofPMStreatmentsconcluded therewassufficientevidencetorecommendcalciumforPMS.

• Giventhatmanywomen,especiallyadolescents,donotmeettheadequateintakerecommendationsfordietarycalcium,a3-

monthtrialof500mgBIDcalciumisreasonable.

Freeman EW.Expert Opin Pharmacother 2010;11(17):2879-89

WhelanAM,etal.CanJClin Pharmacol 2009;16(3):e407-29


CalciumSupplements

• You need roughly 1000 mg per day of calcium from all sources, depending upon age.

• Chelated calcium (citrate, malate)• Best for those over 50 years old or

those taking drugs to suppress stomach acid

• Do not take at the same time as other medications (thyroid, bisphosphonates, phenytoin, tetracycline)

SpenceLA,etal.Nutr Rev2013;71(1):15-22


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DrugInducedOsteoporosis

• Thesedrugsinclude:– Glucocorticoids(steroids)– 1:5casesofosteoporosis– Aromataseinhibitors(breastcancer)– Anti-androgentherapy(prostatecancer)– Protonpumpinhibitors(heartburn)– Antiretroviraldrugs(HIV,hepatitis)– SSRIs(antidepressants)andantipsychotics– Anticonvulsants(epilepsy)– Loopdiuretics(e.g. lasix)– Heparinandoralanticoagulants

Mazziotti G,etal.AmJMed2010;123:877-84


VitaminD• Vitamin D interacts with more than 1000 genes• Vitally important for calcium regulation (bones, heart, etc)• Review of 30 studies show that high vitamin D status is

strongly associated with better breast cancer survival.• Review ~ 1,000,000 participants found 10 ng/mL

increment in blood 25(OH)D level conferred a 26% reduction in risk for colorectal cancer

• MANY older individuals have low vitamin D, which leads to muscle weakness and lower back and hip pain.

• Obesity increases the risk of deficiency……..

Kim Y, et al. Br J Cancer 2014; 110(11):2772-84. Ma Y, et al. J Clin Oncol 2011; 29(28):3775-82


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EndocrineSocietyClinical

PracticeGuidelines

• Serum25(OH)Dlevelusedtoevaluatehigh-riskfolks– Insufficiencydefinedas21-29ng/mL– Deficiencydefinedas

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EndocrineSocietyGuidelines

“Forclinicalcare,itappearsthatallcurrent(testing)methodologiesareadequateifonetargetsa25(OH)Dvaluehigherthancurrentcutpoints; forexample,avalueof40ng/ml(100nmol/L)iswithouttoxicityandvirtuallyensuresthattheindividuals‘true’valueisgreaterthan30ng/ml(75nmol/L).”

Holick MF,etal.JClin Endocrinol Metab 2011;96(7):1911-30


VitaminD

CDCfound:• 66.8millionAmericans1

yearandolderhadvitaminDlevelsbetween12-20ng/ml

• 23millionAmericanshadserumlevels

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VitaminK

• TherearetwomainformsofvitaminK.– Phylloquinone, orvitaminK1,issynthesizedbyplantsandmakesup90%ofthevitaminKobtainedinthediet.Best

sourcesaregreenleafyvegetables.Fat-solublesoshouldbeeatenwithsomehealthyfat.

– Menaquinone,vitaminK2,isresultofbacterialactioninGItractconvertingK1toK2orobtaineddirectlyfromfoodsourcessuchasmeat,eggyolks,fermenteddairyandsoy

(e.g.,miso,natto).



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Geleijnse JM,etal. JNutr.2004;134(11):3100-5.


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Magnesium

• Lowmagnesiumintakesandlowbloodlevelshavebeenassociatedwithtype2diabetes,metabolic syndrome,elevatedCRP,hypertension,atherosclerotic vasculardisease,suddencardiacdeath,osteoporosis,migraineheadache,asthma,andcoloncancer.

• 48%ofUSpopulationconsumeslessthantherequiredamountofdailymagnesium.

Rosanoff A,etal.Nutr Rev70(3):153-64.


MagnesiumandBloodPressure

• 3954apparentlyhealthyMexicanchildrenwereenrolled inacross-sectionalstudy.

• Hypomagnesemia (

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ToGet400mgMagnesium

• 115almonds,whole• 2.5cupsboiledspinach• 6.5cupssoymilk,plainorvanilla• 17sliceswholewheatbread• 3.5cupscooked blackbeans• 4.7cupscooked brownrice• 9cupsraw,cubedavocado• 3cupspumpkinseeds

MagnesiumandtheHeart

• Low serum magnesium levels associated with higher all-cause and cardiovascular mortality.

• Review of 44 studies shows Mg supplements enhance blood-pressure lowering effect of BP medications in stage 1 hypertension when given 230-460 mg/d.

• Nurses Health Study (88,375 women) found that for every 0.25-mg/dL increment in plasma magnesium –41% lower risk of sudden cardiac death. Women with lowest levels of magnesium also had significantly increased risk of stroke.

Reffelmann, et al. Atherosclerosis 2011 Nov;219(1):280-4. Rosanoff, et al. Magnes Res 2010 Mar;23(1):27-40. Chiuve, et al. Am J Clin Nutr. 2011;93(2):253-60.Akarolo-Anthony SN, et al. Stroke 2014; 45(10):2881-6


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Ulcer/GERDMedications

DrugClassification NutrientDepletion

Protonpumpinhibitors Magnesium,iron,calcium,vitaminB12,

folicacid,zinc,vitaminC,vitaminD(?)

H2antagonists folicacid

• There were 118.5 million prescriptions for PPIs in 2010 with roughly $11.4 billion in sales. Thesenumbersdonotinclude over-the-countersalesforPPIs.

- esomeprazole magnesium (Nexium) - omeprazole (Prilosec)

- pantoprazole sodium (Protonix) - rabeprazole sodium (Aciphex)

- lansoprazole (Prevacid) - dexlansoprazole (Dexilant)

- omeprazole and sodium bicarbonate (Zegerid)


FDASafetyAdvisory

• FDA issued a MedWatch warning and label change for PPIs due to low magnesium levels associated with long-term use.

• Those taking medications, generally more than one year, may end up with low magnesium, which can put them at risk for seizures, irregular heartbeats, and muscle spasms.”

• Review of nine studies (n=115,455) found that the odds of developing hypomagnesia increased by 75% if taking PPIs.

• FDA advises magnesium levels be checked before and periodically during treatment.

ParkCH,etal.PLoS One2014;Nov13;9(11):e112558.


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Magnesiumfor

Migraines

• Studiesshowthatmigraineurs havelowbrainMgduringmigraineattacksandmayhavesystemicMgdeficiency.

• Mgreducesrecurrentpediatricmigraineandtensionheadaches.

• CanadianHeadacheSocietygavemagnesiumcitrateastrongrecommendationforprophylaxisofmigraine.

• Dosegenerally300-400mg/d.Diarrheamostcommonsideeffect(glycinate andcitrateformslessGIcomplaintsthanoxide).

Sun-EdelsteinC,Mauskop A.Clin JPain.2009Jun;25(5):446-52.

Pringsheim T,etal.CanJNeurol Sci 2012;39(2Suppl)S1-59

Mauskop A,etal.JNeuralTransm 2012;119(5):575-9.


Butterbur Extract(Petasites hybridus)

• Butterbur has a Level A (highest) recommendation for migraine prevention in adults from the American Academy of Neurology and American Headache Society and is “strongly recommended”

• Extracts should be PA free and contain ~7.5% petasin. – Children 6-9 years take 25 milligrams BID– Children 9-13 take 50 milligrams BID. – Children > 13 yrs. and adults take 75 mg BID

HollandS,etal.Neurology2012;78(17):1346-53


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MelatoninandHeartburn

• MelatoninInhibitsgastricacidsecretion,increasesgastrin,whichstimulatescontractionofloweresophagealsphincter.

• Studyof60patientswithGERDbyendoscopycomparedtocontrols.Received:

– 3mgmelatonin– 20mgomeprazole– 3mgmelatonin+20mgomeprazole

• Heartburn/epigastric paindecreasedafter4weeksandcompletelyresolvedin8weeksinallthreegroups.

• Onlygroupswithmelatoninhasimprovedsphincterfunction.

Kandil TS,etal.BMCGastroenterol 2010;10:7.

Copyright © 2016 Integrative Medicine Concepts, LLC. All Rights Reserved.Copyright©2016IntegrativeMedicineConcepts,LLC.AllRightsReserved.

Safety

• Shorttermuseofmelatoninatevenveryhighdosesisnotassociatedwithanysignificantsideeffects.

• Long-termtreatmentisnotassociatedwithanysignificantsideeffects,comparabletoplacebo.

• Safetydatainpregnancy,lactationandinyoungchildren isstillbeingevaluated.

AndersenLP,etal.Clin DrugInvestig 2015;Dec 21


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Turmeric(Curcuma longa)


Turmeric

• Curcumin istheyellowpigmentinturmericandhaspowerfulhealthbenefits.Humanandanimaldatasuggestitmaybebeneficialfor:

– Brainhealth– Inflammation– Heartdisease– Cancer– Depression– Skin Conditions


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Factors affecting the Intestinal Microbiome

• C-section birth• Lack of breastfeeding• Antibiotics and NSAIDs• Microbial infections• Diet (highly processed, low fiber foods)• Chronic diarrhea• Persistent stress• Radiation and chemotherapy


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ProbioticsandOralHealth

• A systematic review of probiotic strains for caries prevention showed promising results but only a few studies have demonstrated clear clinical outcomes.

• More than 14 strains have been researched.• A continuous regular almost daily intake is

probably required.Cagetti MG,etal.Nutrients2013;5(7):2530-50.


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1. Resultsfromanimbalanceinthecolonicmicrobiota

2. Probiotictreatment canreducetheincidenceand severityofAAD

3. EfficacyofprobioticAADpreventionisdependentontheprobioticstrain(s)usedandonthedosage.

– Saccharomycesboulardii 500mgBID– LactobacillusGG1billioncolonyformingunitsBID– Lactobacillus reuteri 1billioncolonyformingunitsBID

AntibioticAssociatedDiarrhea(AAD)

Iodine


• ManyreproductiveagedwomeninUShavemarginaliodinestatus;saltinprocessed foods

isnotiodized.

• Deficiencyassociatedwithpregnancyloss andprematurity,ADHD,lowerIQandother

neurocognitivedefectsinthefetus.

• AmericanThyroidAssociation recommendspregnant/lactatingwomensupplement: 150

mcg/dpotassium iodide.• Vastmajorityofofprenatalvitaminsdonot

containiodine.

Council onEnvironmentalHealth,etal.Pediatrics 2014;133(6):1163-

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CDC2nd NationalReportonBiochemicalIndicatorsofDiet

AndNutrition.TheWHOrecommendsthatthemedianUIinpregnancybe150-249mcg/L.

Resources• FortifyYourLife,TieraonaLowDog,MDwithNational

Geographic

• DietarySupplementLabelDatabase:dsld.nlm.nih.gov• NIHNationalCenterforComplementaryandIntegrative

Health(NCCIH): nccih.nih.gov

• OfficeofDietarySupplements: ods.od.nih.gov• LinusPaulingInstitute: lpi.oregonstate.edu• ConsumerLabs:www.consumerlabs.com• NaturalMedicinesComprehensiveDatabase:

naturaldatabase.com


Documents

Per 1994 Dietary Supplement Health Education ActDietary Supplement Health Education Act • A dietary supplement is a product taken by mouth that contains a "dietary ingredient" intended